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  • Writer's pictureOren Zarif

Cerebellar Stroke Symptoms and Diagnosis - Oren Zarif - Cerebellar Stroke

Although the symptoms of cerebellar stroke are typically non-specific, it is important to get proper diagnosis at the earliest stage of the disease. Cerebellar lesions present with non-specific symptoms, such as difficulty with vision and coordination. Many survivors of cerebellar stroke ignore these symptoms, waiting until they are severe to seek medical help. Unfortunately, this is not always the case, and there are many ways to detect the presence of cerebellar lesions.

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Cerebellar infarcts may be very small, with a diameter of less than two centimeters. These infarctions may be very small or very large, based on neuropathological findings. Cerebellar infarcts may also be grouped by lobe or are end-territorial in nature. Because these infarctions are so small, they may not be identified until the brain is already significantly damaged.

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Patients with a cerebellar infarction may also present with similar symptoms as those of hemorrhage or infarction. The latter should be treated as a neurologic emergency. Imaging is essential for proper diagnosis, especially if the hematoma is growing and compressing the brain stem. Patients may also develop depressed consciousness, irregular breathing, and coma. In these cases, surgical evacuation is required to restore neurological function.

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The clinical features of cerebellar infarctions are useful in guiding surgical management. Although imaging findings can be helpful in guiding neurologic treatment, they cannot determine aggressive surgical management. The overall clinical gestalt of the patient must remain the key to patient outcome. Repeated imaging may also allow for more tailored surgical approaches. In some cases, a ventriculostomy may be sufficient to restore temporal stability. However, in cases where progressive brainstem compression is the result, craniectomy is the definitive treatment.

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Clinical features that predict poor outcome include high systolic blood pressure, visible brainstem distortion, acute hydrocephalus, and abnormal corneal and oculocephalic reflexes on CT. Patients with a higher Rankin score at 3 months post-stroke had the best outcomes. However, in the majority of patients with cerebellar infarction, the symptomatology and prognosis are similar and should be assessed as a result

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Cerebellar stroke is uncommon - less than 2% of all strokes affect the cerebellum. Cerebellar stroke survivors should ask questions of their medical professionals during the recovery phase. They will learn about unique symptoms, best rehabilitation practices, and an approximate timeline for recovery. And because cerebellar stroke recovery is rare, it is important to seek the care of a stroke specialist early. So that the recovery process can go as smoothly as possible, they can focus on the next step: rehabilitation.

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One study sought to examine the clinical outcomes of isolated cerebellar stroke patients, and to determine factors that influence recovery. The authors included 15 patients with acute cerebellar stroke who had a standard stroke MRI on the day of admission and were assessed for mRS, NIHSS, and modified International Cooperative Ataxia Rating Scale on days one, three, seven, and 30. They performed statistical analyses of the data using a generalized linear model to determine the effects of stroke lesion location, patient age, and MICARS score at admission.

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A vascular anastomosis between the basilar artery and the posterior inferior cerebellar artery supplies the superior and inferior surfaces of the cerebellum. The PICA has circumferential branches that run perpendicular to the cerebellar folia. Anastomoses between the two arteries are constant in individuals. They also supply the posterior and superior surfaces of the cerebellum. When one artery is blocked, a stroke in the cerebellum is often fatal.

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